Early in 2014, the gifted comedian Robin Williams was diagnosed with Lewy body disease, which usually progresses to Lewy body dementia. A few months later, he took his life. We will never know whether the beloved comic succumbed to despair or to his disease. Dementia can cause depression that leads to suicide. And suicide in dementia is shockingly common.
In the United States, older adults make up 12 percent of the population but account for 18 percent of suicides. Some researchers believe that suicide rates in the elderly may be underreported by 40 percent or more. "Silent suicide" by starvation, dehydration, overdose, and "accidents" are not reported as suicide but may result from suicidal intent.
The answer for depression in dementia isn't an antidepressant medication, although antidepressant medication sometimes is necessary. Depression in dementia is a difficult issue, and it's not something you can "fix". However, there are positive steps for caregivers that make a difference.
Recognize the symptoms of depression
Someone who has dementia may not be able to tell you "I am depressed". You may have to infer their emotional state from their actions.
- Extended periods of crying and tearfulness may indicate depression. (Brief periods of inappropriate crying may be a symptom of pseudobulbar affect disorder, which is not a form of dementia.)
- Unexplained weight loss may be a sign of depression. Or it may be a sign of problems with chewing and swallowing, digestive issues, allergies, or poor food preparation.
- Changes in sleep habits herald depression. Both insomnia and excessive sleepiness are signs of depression. But they may also be caused by noise, odors, and interruptions during the night.
- Fatigue often accompanies depression. As with other possible signs of depression, fatigue is symptomatic of multiple possible health conditions. But it is part of a syndrome of depression.
- Agitation and irritation increase during mild to moderate depression. If wandering, verbal confrontation, and flares of temper occur without their usual triggers, consider depression.
- Unusual collections of complaints are possible during depression. An accumulation of "not quite treatable" complaints is both depressing and indicative of depression.
- Apathy and lack of interest are common in depression. Loss of interest in prized possessions, favorite foods, and eagerly anticipated activities are signs of depression. One "test" for depression is to arrange an event that is usually eagerly anticipated, and then observe the patient's reaction. For instance, if someone who has dementia always watches a particular sports team on television each and every weekend, not wanting to watch the game may be a sign of depression. Grandparents who don't want to see grandchildren may be depressed. And patients who enjoy being "cantankerous" who are strangely quiet may be depressed.
Collaborate with other caregivers
Chances are that you aren't the only person who has noticed signs of depression. If is important to share your observations with the team of caregivers who deal with your loved on a daily basis, and it is good to bring up the issue with the doctor. (Screening for depression is part of every encounter with a doctor in many medical practices.) If someone who has dementia is anxious when a caregiver leaves the house or the nursing facility at the end of their shift, be sure to speak with that person to find out what is going on that makes the patient want them to stay. They may be doing something that relieves the patient's depression.
Don't forget to take care of yourself
One study found that 12 percent of family members of people who have dementia develop major depression in the course of their loved one's illness. The emotional, physical, and financial stresses of taking care of a chronically disabled loved one who will not recover can be devastating. Be sure to schedule time for your own recreation and rest. And if you yourself develop thoughts of your own suicide, see professional help. There is no shame in being helped.